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7 - � v -�7 -. APPLICATION FOR PERMIT SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E. HAZE i ON AVE., STOCKTON, CA Telephone (209) 466-6781f 1 r�' '54 uf4jteR PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and/or install the work herein described. This application is made in compliance with San Joaquin County Ordinance No.549 for sewage or No. 1862 for well/pump and the Rules and Regu]ztions of the San Joaquin Local Health District. Job Address _SHARPE ARMY DEPOT LATHROP C' I7.S. ARMY TOXIC ANcityLot Size PM Owner's Name HAZARDOUS MATERIALS AGENQ, ABERDEEN PROVING GROUND, MD ress Phone NORTH VALLEY' DRILLIN P•0. BOX 108 21010-5401 (916) j Contractor CPtldress.�QRNINLicense No.49897,7 Phone 382A ! TYPE OF WELL/PUMP: NEW WELL WELL REPLACEMENT ❑ DESTRUCTION 0 t PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ OTHER 0 DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE r FOUNDATION AGRICULTURE WELL OTHER WELL—_ PITS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ Industrial ❑ Open Bottom C Manteca Dia. of Well Excavation 10 Dia. of Well Casing 411 Domestic/Private M Gravel Pack ❑ Tracy Type of Casing PVC Specifications PORTLAND Public ❑ Other ❑ Delta Depth of Grout Seal VARIABLE Type of Grout CEMENT r 7 Irrigation Approx. Depth ❑ Eastern Surface Seal Installed by ' Repair Work Done -❑ Type of Pump H.P. State Work Done Well Destruction ❑ Well Diameter 411 I•D• Sealing Material [top 501 PORTLAND_CEMENT/BENTONITE Depth VARIABLESAND Material (Below 50') SAND (SCREEN AREA TYPE OF SL-PTIC.WORK: NEW INSTALLATION El REPAIR/ADDITION ❑ DESTRUCTION ❑ (No septic system permitted if public sewer is available within 200 feet.) r Installation will serve, Residence_ Commercial_ Other Number of living units: Number of bedrooms Character of soil to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No, Compartments PKG, TREATMENT PLT. ❑ Method of Disposal _ Distance to nearest: Well Foundation P.operty Line , LEACH;NG LINE ❑ No, & Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line _ 1 SEEPAGE PITS ❑ Depth Size Number — SUMPS i ❑ Distance to nearest: Well Foundation Property Line DISPOSAL PONDS 0 t l hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin county Ordinances, state laws, and rules and regulations of the San Joaquin Local Health District. Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or sub-contracting signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall employ pbrsons subject to workman's compensa- tion laws of California." 7 The applicant ust call for all quired in ctions, Complete drawing on reverse side. t Signed Title: ESE, GEOLOGIST Date: 7/1/87 _ e - j Y Cl j-La� D";"1 '?- FOR DE FITMENT USE-'ONLY Application Accepted by Dat'e-_ Area Date Final Inspection bye Pit or Grout Inspection by Additional Comments ❑ Stk 466-6781 n Lodi 369-3621 ❑ Manteca 823-7104 ❑ Tracy 83 s Applicant- Return all copies to: Environmental Health Permit/Services 1601 E. Hazelton Ave., P.O. Box 2009, Stk., CA 95201 FEE MOUNT DUE AMOUNT REMITTED ASR RECEIVED BY DATE PERMIT N0. INFO + EH 13-25 4REV,1's 51 r^ EH 14-2 — f.4YK S f OL�i 1/isf 7s � e2 � A, s;- —CIV 51 v. I ) C), a:aa 7 1�1 m- r o i r�S�P G ._1 nS""o,�tq' >�o r. o i ► t �.1 -s ! CtGyr l�i t^o J'r S � - 4 �o' scd��►I �33� t,��C J �' n% 1.57 / oVfi qT A �jC41 9 lr(13�6I�d7 / I d f f t-(-17 -2-PmG ro of i s ms C-'f/o rr s ori q-q 3 j 13 M o vl it f-i✓) s 3 A .127 r �o� jot s t~r-"/ t 1�'Sc>n t� S -�O n r^--/ �.c 9 {, go, �p`[�1Q� ��' Soman _V r sc-yld�� `r o t o r ! On�1 0! r II 7— '-97 /7/n "W i n.; ape -hon_5�0 nar S'7w Ig1or Sca�en ,-1rr�S sa.rt � Sr .. �-ov t